Saturday, March 9, 2019

Deceased donation of organs for transplant: recent policy discussions

Here's a list of links about recent discussions about how deceased donor organs are recovered and used in the U.S.

First, a 2017 article in the American Journal of Transplantation on how OPO's (Organ Procurement Organizations) are measured:

Changing Metrics of Organ Procurement Organization Performance in Order to Increase Organ Donation Rates in the United States
D. Goldberg  M. J. Kallan  L. Fu  M. Ciccarone  J. Ramirez  P. Rosenberg  J. Arnold G. Segal  K. P. Moritsugu  H. Nathan  R. Hasz  P. L. Abt

Abstract: The shortage of deceased‐donor organs is compounded by donation metrics that fail to account for the total pool of possible donors, leading to ambiguous donor statistics. We sought to assess potential metrics of organ procurement organizations (OPOs) utilizing data from the Nationwide Inpatient Sample (NIS) from 2009–2012 and State Inpatient Databases (SIDs) from 2008–2014. A possible donor was defined as a ventilated inpatient death ≤75 years of age, without multi‐organ system failure, sepsis, or cancer, whose cause of death was consistent with organ donation. These estimates were compared to patient‐level data from chart review from two large OPOs. Among 2,907,658 inpatient deaths from 2009–2012, 96,028 (3.3%) were a “possible deceased‐organ donor.” The two proposed metrics of OPO performance were: (1) donation percentage (percentage of possible deceased‐donors who become actual donors; range: 20.0–57.0%); and (2) organs transplanted per possible donor (range: 0.52–1.74). These metrics allow for comparisons of OPO performance and geographic‐level donation rates, and identify areas in greatest need of interventions to improve donation rates. We demonstrate that administrative data can be used to identify possible deceased donors in the US and could be a data source for CMS to implement new OPO performance metrics in a standardized fashion.

Here's an optimistic report from the Bridgespan Group, sponsored by the Arnold Foundation:
Reforming Organ Donation in AmericaSaving 25,000 Lives per Year and $13 Billion in Taxpayer Funds over Five Years

"There ispotential to recover up to 28,000 more organs from deceased donors per year, saving thousands of lives and billions in taxpayer funds from the avoided costs of dialysis and increased productivity.The gap between the number of transplants performed and this potential persists in great part due to a system of misaligned policy incentives—key players have competing agendas that are not aligned to maximize the number of organs transplanted. Transplant centers, while dedicated to patient care, adjust their level of risk aversion based on overly strict acceptance criteria and at times decline to use lifesaving organs. Organ procurement organizations (OPOs), which lead procurement of organs from deceased donors, must comply with an evaluation system that does not actually reward pursuing every organ, every time. Donor hospitals lack incentive to do more than the bare minimum of referring potential deaths to OPOs. ..."

Here's a pessimistic report from the Washington Post:

Despite low performance, organ collection group gets new federal contract

"Federal regulators in June took the unusual step of announcing they would shut down a New York-based nonprofit organization responsible for recovering human organs for transplantation. On Friday, regulators reversed that decision even though the organization, LiveOnNY, has received poor performance scores for nearly a decade and its organ recovery rates remain among the lowest in the nation."


"27,455 Total potential donors
Using the latest data and methodology, The Post identified a large pool of ideal donors: People who were already on ventilators when they died and were either declared brain dead or whose organs could be recovered after their hearts stopped beating.
"9,971 Actual organ donors
The U.S. transplant system recovered organs from less than half of potential donors in 2016."

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